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UNDERGROUP" TANK PROGRAM OFFICIAL INSP`TION REPORT <br /> , SAN JOAQUIN HEALTH DISTRICT.; <br /> 1601 E. HAZELTON AVE. q <br /> COUNTY NAME �y STOCKTON, CA 95205 COUNTY # 3 <br /> S Qivt �B Q PHONE NO. 468-3423 <br /> SITE NAME: % � INSPECTION DATE: �- 5 <br /> SITE ADDRESS: CITY/STATE/ZI�f , �� ��j a J <br /> CHANGES SITE YES NO TANK / TANK TANK TANK <br /> FORM AAND/OR B SUBMITTED? COMPUTER COMPUTER COMPUTER COMPUTER <br /> NUMBER NUMBER NUMBER NUMBER <br /> TYPE OF INS ECTION SITE COMPUTER# PER# PER# PER# PER# <br /> r TE EXP.DATE EXP.DATE EXP.DATE EXP.DATE <br /> OPERATIONAL TANK [11 <br /> NTENTS <br /> MINOR <br /> PERMIT TO OPERATE 2 <br /> CHANGE IN CONDITIONS TO OPERATE 4 <br /> APPROVED CONSTRUCTION 6 <br /> WRITTEN MONITORING PROCEDURES 8 �$ <br /> APPROVED MONITORING SYSTEM 10 � <br /> MONITORING SYSTEM 12APPROVED MONITOR FREQUENCY 14MONITORING RECORDS MAINTAINED 16ACCESS CASING SECURED 18 <br /> PIPING 20 <br /> INVENTORY RECONCILIATION 21 22 <br /> TANK GAUGING 23 24 <br /> APPROVED RESPONSE PLAN 25 26 <br /> UNAUTHORIZED RELEASE OCCURRENCE 27 28 <br /> SAMPLING 29 30 _ <br /> APPROVED TANK REPAIRS 31 32 <br /> UNAUTHORIZED RELEASES REPORTED 33 34 <br /> SAFETY HAZARD 35 36 <br /> CONDITIONS ABATED 37 ✓ <br /> TEMPORARY TANK CLOSURE <br /> REMOVAL OF RESIDUAL 38 39 <br /> FLAMMABLE VAPORS REMOVED 40 _ <br /> ACCESS LOCATIONS SEALED 41 42 <br /> POWER DISCONNECTED 43 _ <br /> OWNER/OPERATOR MONITORING 44 45 <br /> 7 <br /> PERMANENT TANK CLOSURE <br /> REMOVAL OF RESIDUAL MATERIALS 46 47 <br /> PIPING 48 49 <br /> FLAMMABLE VAPORS REMOVED 50 <br /> UNAUTHORIZED RELEASE 51 52 <br /> SAMPLING 53 54 <br /> IMPROPER ABANDONMENT 55 56 <br /> THE MARKED ITEMS REPRESENT VIOLATIONS AND MUST BE CORRECTED AS <br /> SYSTEM STATUS(MUST MARK ONE) FOLLOWS: <br /> MAJOR 57 MINOR 58 NO 59 <br /> VIOL ❑ VIOL. ❑ VIOL <br /> OFFICE: INSP: RECEIVED BY: <br /> [ i. <br /> TITLE: RoEt4 C PHONE: RECK: <br /> HUT-3 ORIGINAL J 5/W ©" <br />